By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

• The American Heart Association  is offering access to online tools , including one that helps you understand your heart health.

• America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

• The Y is expanding coverage of its diabetes prevention program  and other national disease prevention programs to better address risks for diabetes, heart attack, and stroke.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012

Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm

By Michelle Andrews

Photo by Mad Max

One in 500 kids has an inherited disorder that causes high levels of LDL (“bad”) cholesterol that may require medication to control.However, since the problem doesn’t create observable symptoms, as many as half of these kids don’t know they have the condition.

To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21.

Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed.

Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese.

Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say.

Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good.

To learn more read the LocalHealthGuide article: Should kids with high cholesterol be put on drugs? 

To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says.

The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn’t enough evidence to recommend for or against routine lipid screening in children and adolescents.

Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says.

Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines.

More From This Series: Insuring Your Health

“Family history doesn’t really catch everybody” with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children’s Hospital Boston.

In addition, she says, “Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they’re much more focused.”

That’s the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy – until Bill had a heart attack two years ago at age 47.

The pediatrician for their three children checked the kids’ cholesterol and found that while levels for the two girls – Chelsea, now 17, and Chandler, 13 – were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)

Julie Brothers, medical director of the lipid heart clinic at Children’s Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. “None of us wants to slap medication on anyone,” she says.

Maybe not. “But if you’re going to test every child, it’s a sure bet you’re going to be medicating more kids,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening.

Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven’t enrolled more than a few hundred kids, and none has followed them for more than two years, say experts.

“We don’t know what taking a 10- to 11-year-old kid and putting them on statins long term will do,” says Frederick Rivara, division chief of general pediatrics at Seattle Children’s Hospital and co-author of one of the JAMA articles.

Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents.

“The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program,” he says.

PHOTO by Mad Max – GNU Free Documentation License

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Michelle Andrews

The 2010 health-care overhaul creates state-based health plans for those who have medical conditions that make them uninsurable in the private market.

These “preexisting-condition insurance plans” (PCIPs) are intended to act as a bridge until 2014, when insurers will no longer be able to refuse to cover people with medical problems or charge them more than other consumers.

As of November, about 45,000 people had signed up for those plans, far fewer than the up to 400,000 that was originally projected.

However, there is a much larger group, more than 220,000 people, who have coverage through 35 state high-risk pools that were in existence before the overhaul was passed.

Because of restrictions in the new law, they can’t sign up for the PCIP plans, even though the coverage is often cheaper (thanks in part to federal funding) and more comprehensive. For these people, 2014 can’t come soon enough..

Together they pay $1,304 a month for coverage. Chris’s plan has a $2,500 deductible while Kristi’s is $1,000. The plans generally cover 80 percent of their medical bills.

Chris Petersen, who supported the health-care overhaul, nevertheless thinks the law failed him and his wife. “This is the biggest check I write out every month,” he says. “The new federal plan would have been a lot cheaper.”

If the Petersens had been allowed to sign up with the PCIP in Iowa, their combined premium would have been $958 for policies with $1,000 deductibles.

More From This Series: Insuring Your Health

People such as the Petersens, however, are stuck between a rock and a hard place: To qualify for a PCIP, they must first be uninsured for six months.

Experts say this requirement was included in the law to discourage people in the existing state high-risk pools and other private insurance plans from doing exactly what they would do if better, cheaper coverage became available: switch plans.

It’s clear why they might be tempted. Premiums in the new pools can’t exceed rates for standard individual coverage in the state, while the high-risk pools in some states charge twice that. The new plans must also cover preexisting conditions immediately, in contrast to the older state pools, some of which exclude such coverage for up to a year.

“Much as everybody would like to drop [the six-month requirement], if you did you’d have to increase expenditures,” says Sandy Praeger, the Kansas insurance commissioner, who chairs the health insurance and managed-care committee of the National Association of Insurance Commissioners. Federal funding for the program through 2013 is $5 billion.

Learn about Washington State’s Pre-existing Condition Insurance here.

Although enrollment in the PCIPs has been far lower than originally projected, health-care spending by the individuals who have signed up for coverage has been much higher than anticipated, say experts.

“The people coming into the PCIPs act more like the long-term uninsured,” says Jean Hall, an associate research professor at the University of Kansas who co-authored a report about the PCIPs for the Commonwealth Fund. “They’re not accustomed to managing on a day-to-day basis; they’re accustomed to going to the emergency department when things get bad.”

Nine states have asked the Department of Health and Human Services for more money to fund their PCIPs in 2012. However, it appears the program won’t run out of money soon. Through the end of September 2011, just $386 million of the $5 billion allocated had been spent, according to HHS figures.

(Some experts caution against relying too much on September spending figures, since enrollment has increased since then and claims may take months to clear.)

“As you would expect, some states have exceeded projections and others have not,” says an HHS spokesman. “We have the capacity to accommodate the needs of the program.”

For people who can’t get into the new plans, however, that’s small comfort.

Jill Judy and Mark Brown signed up for the Arkansas high-risk pool a few years ago when Mark’s benefits ran out after his retirement from a management job at a company that repossesses boats. Judy, 49, has mild cerebral palsy, which she hasn’t been treated for since she was a child, and Brown, 62, had an angioplasty 15 years ago and still sees a cardiologist.

Individual insurers wouldn’t cover them, so they ended up in the state’s high-risk pool. Although Judy says she’s grateful that she has coverage, it’s hardly ideal.

The premiums for the two of them come to just under $1,000 a month. But the plan has a $10,000 deductible and a $1 million cap on lifetime benefits. “People like my husband and myself are paying $12,000 a year for nothing,” she says.

She estimates they could get better coverage and save 30 percent in the Arkansas PCIP. “But we don’t qualify because we’re not willing to be uninsured for six months,” she says. “It’s screwy.”

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

Local Resources:

• Statewide Health Insurance Benifits Advisors (SHIBA) provides free, unbiased advice from volunteers: www.oic.wa.gov/shiba/
• Benefits.gov: www.benefits.gov
• King County Project Access: www.kcprojectaccess.org
• Washington Basic Health (insurance assistance): www.basichealth.hca.wa.gov/understanding.shtml
• Washington Health Plan: www.washingtonhealth.hca.wa.gov
• Washington State Office of the Insurance Commissioner: www.insurance.wa.gov
• To search for a community clinic near you go to: http://findahealthcenter.hrsa.gov

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Valerie DeBenedette, Contributing Writer

Research shows that teens who drive with peers as passengers have increased risks of crashing. Many states have responded by creating graduated driver licensing laws which include limits on the number of passengers teen drivers can have.

Two new studies in the latest Journal of Adolescent Health reviewed key factors shown to influence teen driving behaviors: perception of driving risks, parental monitoring and the presence of peer passengers.

Both studies have results that support the role of teen driver licensing restrictions and parental oversight as effective methods to prevent teen driver accidents.

Teen drivers with a stronger awareness of risks and with parents who monitor their whereabouts and set rules engage in less risky driving behavior, according to the first study.

A second study showed that teen passengers distract both male and female teen drivers, and are linked to aggressive or illegal driving by male teen drivers. Researchers at the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia led both studies.

The first study researched how sensation seeking or risk taking, risk perception and parental monitoring and rule setting affected a teen’s likelihood of risky driving and driving with multiple peer passengers.The researchers surveyed 198 teens aged 15 to 17 in two states with graduated driver license laws.

They found that higher sensation seeking, lower risk perception and less parental monitoring predicted teens’ risky driving, and having multiple peer passengers increased that risk.

“The good news is that most of the teens in the study reported being aware of the risks of driving dangerously,” said lead author Jessica Mirman, Ph.D.

Findings from on-scene crash investigations revealed that both male and female teen drivers were more susceptible to distractions with passengers in the car.

In addition, boys with multiple passengers were more likely to drive aggressively or perform illegal maneuvers in the moments before a crash when they had passengers than they were when driving alone.

“Distraction from peer passengers appears to play a prominent role for both male and female drivers,” said Allison E. Curry, Ph.D., MPH, director of the Epidemiology and Biostatistics Core at the Center and lead author on this study. “One in five females and one in four males who were driving with friends were distracted by something inside the vehicle just before they crashed.”

Passengers affected boys and girls in different ways. Boys were more prone to crash due to speeding or reckless driving while girls were more apt to crash because of distractions such as looking at their friends, eating, texting or using their cell phones, said Jeffrey Weiss, M.D., pediatric hospitalist at Phoenix Children’s Hospital, and a spokesman for the American Academy of Pediatrics on teen driving issues.

“The $64,000 question about graduated driver’s licensing rules is, ‘Why do they work?’” Weiss noted. “We’ve shown that they work, but is it because of the passenger restriction or the night restriction or a combination of both? Is it because of parental education?”

Some of the beneficial effect might be because some teens wait to drive until they can get a full license without restrictions, he added.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Signs that read, “Burn Calories, Not Electricity” posted in lobbies of New York City buildings, motivated more people to take the stairs and continue to use them even months later.

A new study, which appears online in the February issue of the American Journal of Preventive Medicine, observed and analyzed people making 18,462 trips up and down stairs at three sites. The signs immediately increased stair use between 9.2 and 34.7 percent at all locations.

“The gains in physical activity continued to be observed nine months after the signs were first placed,” noted Karen K Lee, M.D., author of the study at New York City Department of Health and Mental Hygiene. “We found that placing stair prompts at the point of decision is effective.”

The study is among the first to assess the effects of stair prompts on stair climbing as well as descent in different types of buildings over many months. Prompts were posted in a three-story health clinic, a 10-story affordable housing building, and an 8-story academic site and studied over several months.

“Human-made environments in everyday life offer numerous opportunities for maintaining health, controlling weight and preventing disease,” Lee said. “One of those health opportunities is stair climbing, a vigorous activity which can burn more calories than jogging.”

Instead of removing the signage after the study was completed, the prompts were purposely left in place. New York City continues to promote the health benefits of stair climbing by distributing free stair signs to owners and managers of public and private buildings who request them.

“So far, we’ve distributed over 26,000 signs to owners and managers of about 1,000 buildings including residential, worksites, hospitals and academic centers,” said Lee.

Remington sees opportunities for widespread use of prompts. “For example, a zoning law could be enacted that requires buildings to have stair prompts …like they require signs for exits.”

Remington added, “Overall, this is a great study, showing how for almost no investment we can improve health.”

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.